Somatising in children and adolescents. 1. Clinical presentations and aetiological factors

Somatising in children and adolescents. 2. Management and outcomes

In this paper I outline the assessment, engagement and management of children and adolescents with somatising conditions. The major diagnostic groups, in rough order of prevalence, are adjustment, dissociative (transient and chronic), somatoform and factitious disorders and chronic fatigue. See Eminson (2001) for more detailed descriptions and subtypes.

Clinical features of functional somatic symptoms in children and referral patterns to child and adolescent mental health services

AIM

Functional somatic symptoms (FSS) are common in paediatric patients who are referred to Child and Adolescent Mental Health Service (CAMHS), but little is known about current referral practices. The aim of this study was to systematically investigate clinical features of paediatric inpatients with FSS referred to CAMHS and to describe why paediatricians referred them.

METHODS

The study population comprised 60 children with FSS admitted to a large Danish paediatric department during 2012. We compared medical record data on the clinical characteristics and paediatric management of 16 children who had been referred and 44 children who had not.

RESULTS

Most paediatric records lacked information on psychosocial factors and symptoms. Referred children were significantly more multisymptomatic of FSS (p < 0.01) than the controls, had longer symptom duration, underwent more clinical investigations, had longer paediatric admissions of at least two weeks and received more treatment elements before referral. The most frequently stated referral reason was inadequate treatment response.

CONCLUSION

Paediatric inpatients with more severe FSS were more likely to be referred to CAMHS, but referral reasons were generally vague and psychosocial information was frequently missing. Clinical guidelines are needed to improve and systematise mental health referrals for children with FSS.

Posttraumatic symptom structure across age groups

The applicability of diagnostic criteria of Posttraumatic Stress Disorder to the pediatric population has been a focus of much debate (e.g., Carrion, Weems, Ray, & Reiss, 2002 ), informing changes in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). The current study examined the factor structure of posttraumatic distress among adult versus pediatric samples using confirmatory factor analysis. The analysis was performed on the DSM-IV-adherent Posttraumatic Diagnostic Scale (Foa, Cashman, Jaycox, & Perry, 1997 ) and Child Posttraumatic Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001 ). The sample included 378 adult and 204 child and adolescent victims of diverse single-event traumas. A series of models based on previous findings and DSM-IV specification were evaluated. A 4-factor model (Intrusions, Avoidance, Dysphoria, and Hyperarousal), similar to the DSM-5 model, best fit the data among adults, and a different 4-factor model (Intrusion, Avodiance, Numbing, and Hyperarousal) best fit the data among children and adolescents. Despite some similarity, the posttraumatic symptom profiles of pediatric and adult samples may differ. These differences are not fully incorporated into the DSM-5, and warrant further examination.

Influence of stressors and possible pathways of onset of seventh graders' suicidal ideation in urban and rural areas in Taiwan

BACKGROUND

Suicide is the second leading cause of death among young people in Taiwan. However, few studies have investigated children's suicidal ideation, and longitudinal studies are particularly rare. The purposes of this study were: (1) to describe the proportion of students with suicidal ideation in one month and incidence of suicidal ideation in the 7th graders (the first year of junior high school) living in urban and rural areas; (2) to realize the influence of perceived stressors on the onset of 7th graders' suicidal ideation; and (3) to explore possible pathways through which trigger factors and perceived stressors lead to suicidal ideation.

METHODS

A total of 1,589 students were followed from grade 4 to grade 7. Logistic regression was then used to investigate the influence of perceived stressors on the onset of suicidal ideation in grade 7. Structural equation modeling was used to analyze possible pathways through which trigger factors led to increased pressure from certain stressors which in turn resulted in suicidal ideation.

RESULTS

The proportion of students with suicidal ideation in one month was 2 to 3 times higher in both areas compared to that in elementary school. However, the incidence in the rural area showed a large increase from 10.2% and 9.5% in grades 5 and 6 to 15.5% in grade 7. Urban-rural difference was observed. Important stressors and pathways of suicidal ideation differ between urban and rural areas.

CONCLUSIONS

This study showed that the influential stressors in urban and rural areas might be different. Thus, interventions focused on coping skills for regional specific stressors and trigger factors could be beneficial in the transition time.

The role of perceived well-being in the family, school and peer context in adolescents' subjective health complaints: evidence from a Greek cross-sectional study

BACKGROUND

During adolescence children are usually confronted with an expanding social arena. Apart from families, schools and neighbourhoods, peers, classmates, teachers, and other adult figures gain increasing importance for adolescent socio-emotional adjustment. The aim of the present study was to investigate the extent to which Greek adolescents' perceived well-being in three main social contexts (family, school and peers) predicted self-reported Subjective Health Complaints.

METHODS

Questionnaires were administered to a Greek nation-wide, random, school-based sample of children aged 12-18 years in 2003. Data from 1.087 adolescents were analyzed. A hierarchical regression model with Subjective Health Complaints as the outcome variable was employed in order to i) control for the effects of previously well-established demographic factors (sex, age and subjective economic status) and ii) to identify the unique proportion of variance attributed to each context. Bivariate correlations and multicollinearity were also explored.

RESULTS

As hypothesized, adolescents' perceived well-being in each of the three social contexts appeared to hold unique proportions of variance in self-reported Subjective Health Complaints, after controlling for the effects of sex, age and subjective economic status. In addition, our final model confirmed that the explained variance in SHC was accumulated from each social context studied. The regression models were statistically significant and explained a total of approximately 24% of the variance in Subjective Health Complaints.

CONCLUSIONS

Our study delineated the unique and cumulative contributions of adolescents' perceived well-being in the family, school and peer setting in the explanation of Subjective Health Complaints. Apart from families, schools, teachers and peers appear to have a salient role in adolescent psychosomatic adjustment. A thorough understanding of the relationship between adolescents' Subjective Health Complaints and perceived well-being in their social contexts could not only lead to more effective tailored initiatives, but also to promote a multi- and inter-disciplinary culture in adolescent psychosomatic health.

Dispositional optimism and physical wellbeing: the relevance of culture, gender, and socioeconomic status

The present study examined the relationship between dispositional optimism and physical wellbeing (as reflected in physical symptom reporting) in two groups of American and Jordanian college students. It also assessed moderation effects of culture, gender, and socioeconomic status (SES). Participants were administered a questionnaire consisting of items pertaining to dispositional optimism (as measured by the Revised Life Orientation Test, LOT-R) along with items assessing physical symptom reporting and sociodemographic factors (e.g., gender, socioeconomic status). The results revealed significant negative correlations between dispositional optimism and physical symptom reporting for both American and Jordanian participants, although the magnitude of the correlation for the American group was noticeably larger than that for the Jordanian group. The results also showed that women, especially Jordanians, were more likely than men to report physical symptoms. Among Jordanians, physical symptom reporting was more common among those of lower SES. No statistically significant differences in physical symptom reporting were found between American men and women or between the two cultural groups. Multiple regression analyses revealed no statistically significant interactions between optimism and cultural background, optimism and gender, or optimism and SES. Overall, the results suggest that optimism is the factor most predictive of physical symptom reporting, followed by SES and gender. These results corroborate previous findings on the relationship between dispositional optimism and physical wellbeing, and point to crosscultural differences in relationship patterns. These differences suggest that although personality characteristics such as optimism may play an important role in the physical wellbeing of both Western and non-Western groups, the influence of sociodemographic factors such as gender and SES and their interaction with cultural variables must not be overlooked.

Time Trends in Psychopathology. A 21-year comparison from Germany

OBJECTIVE

Time-trend studies are required to learn about children's mental health status in changing societies. Some international studies have already analyzed secular trends over periods of 10 to 25 years, but the results are inconsistent. Our study aims to detect German time trends of psychopathology in children aged 8-11, from the first large Child Behavior Checklist (CBCL)-based study in Marburg/Germany 1987 until the present day (2008).

METHOD

Parents filled in the CBCL to report psychopathological symptoms in their children. The school-based samples from the years 1987 and 2008 were matched for sex, age, and socioeconomic status. The matched samples each consists of 212 girls and boys (girls: 50.5 %, boys: 49.5 %). MANCOVAs and ANCOVAs were used to test differences in mean CBCL scale scores.

RESULTS

Somatic symptoms showed a significant increase from 1987 to 2008. Similar trends were found for other internalizing symptoms, but did not reach significance. Externalizing symptoms showed no significant increase. Boys showed more aggressive or delinquent behavior and attention problems than girls. The children with the lowest socioeconomic status showed the highest symptom levels in both assessment years.

CONCLUSIONS

The increase in somatic problems might be an effect of changes in expected school performance and economic aspects. The overall high rate of psychopathology in children highlights the necessity of effective prevention and intervention programs, particularly regarding families with lower socioeconomic status.

[Three-week multimodal inpatient treatment of children with chronic pain. First results of the long-term follow-up]

OBJECTIVE

In children and adolescents we investigated the impact of a 3-week inpatient multimodal pain therapy on subjective burden of life, pain intensity, and number of days off from school 3, 6, or 12 months later.

METHODS

At the beginning of therapy (inpatient setting) and 3, 6, and 12 months thereafter (outpatient setting) we collected the respective data using standardized questionnaires. For statistical analysis we used Wilcoxon's signed rank test. A p <0.05 was regarded as statistically significant.

RESULTS

A total of 72 patients aged 7.5-18.2 years suffering daily pain entered the study, most of them being diagnosed with somatoform pain disease. After 3, 6, and 12 months, 65, 27, and 30 patients could be reevaluated. Mean pain intensity of the week before data acquisition was significantly less than at the beginning (2.9, 2.3, and 2.9 vs 6.3) as was the mean number of days off from school due to pain during the 4-week period before each day of data acquisition (1.8, 1.5, and 1.4 vs 9.2). Mean subjective burden of life was significantly less than at the beginning (24.5, 22.0, and 25.8 vs 37.8).

CONCLUSION

Outpatient multimodal pain therapy has a sustained impact on children and adolescents suffering from chronic pain.

Individuelle Kinder — individuelle Kopfschmerzen

In the industrialized nations headache prevalence is increasing in children and adolescents. The nosologic classification determines the therapeutic strategy to follow. Three case reports illustrate the optimal cooperation of both a pediatric outpatient pain clinic and a pediatric psychosomatic pain clinic. We report on (1) a girl aged 2 years and 7 months with a 4-month history of headache episodes lasting about 15 min each with concomitant symptoms; (2) an 11-year-old boy with Schimmelpenning-Feuerstein-Mims syndrome, symptomatic focal epilepsy, psychomotor retardation, mild postinfectious internal hydrocephalus, and repeated heat-triggered episodes of right-sided headache beginning suddenly with a duration of 5-30 min and concomitant flush of his hemiface; and (3) a 12-year-old boy who for about 2 years has suffered from "migraine" 3 times a week, significantly impairing his quality of life. We discuss the patients' courses, diagnostic pitfalls, and therapeutic options. For the optimal treatment of children with headache not easily fitting into one of the categories, with significant comorbidity present, or if there is no adequate response to therapy conforming with guidelines, the help of an interdisciplinary pediatric pain clinic is invaluable.